﻿<?xml version="1.0" encoding="utf-8" ?>
<!-- 275 Patient Information -->
<TransactionSpecification xmlns="http://tempuri.org/X12ParserSpecification.xsd" TransactionSetIdentifierCode="275">
  <Segment SegmentId="BGN"/>
  <Segment SegmentId="DTM"/>
  <Segment SegmentId="TRN"/>
  <Loop LoopId="1000A">
    <Name>TRANSACTION RECEIVER</Name>
    <StartingSegment SegmentId="NM1">
      <EntityIdentifier Code="40"/>
    </StartingSegment>
    <Segment SegmentId="PER"/>
  </Loop>
  <Loop LoopId="1000B">
    <Name>SUBMITTER INFORMATION</Name>
    <StartingSegment SegmentId="NM1">
      <EntityIdentifier Code="41"/>
    </StartingSegment>
  </Loop>
  <Loop LoopId="1000C">
    <Name>SERVICE PROVIDER INFORMATION</Name>
    <StartingSegment SegmentId="NM1">
      <EntityIdentifier Code="1P"/>
    </StartingSegment>
    <Segment SegmentId="REF"/>
  </Loop>
  <Loop LoopId="1000D">
    <Name>PATIENT NAME</Name>
    <StartingSegment SegmentId="NM1">
      <EntityIdentifier Code="QC"/>
    </StartingSegment>
    <Segment SegmentId="REF"/>
    <Segment SegmentId="DTP"/>
  </Loop>
  <Loop LoopId="2000A">
    <Name>ASSIGNED NUMBER</Name>
    <StartingSegment SegmentId="LX"/>
    <Segment SegmentId="TRN"/>
    <Segment SegmentId="STC"/>
    <Segment SegmentId="REF"/>
    <Segment SegmentId="NM1"/>
    <Segment SegmentId="PRV"/>
    <Segment SegmentId="REF"/>
    <Loop LoopId="2100">
      <Name>Date or Time or Period</Name>
      <StartingSegment SegmentId="DTP"/>
      <Segment SegmentId="CAT"/>
      <Segment SegmentId="PID"/>
      <Loop LoopId="2110B">
        <Name>ELECTRONIC FORMAT IDENTIFICATION</Name>
        <StartingSegment SegmentId="EFI"/>
        <Segment SegmentId="BIN"/>
      </Loop>
    </Loop>
  </Loop>
</TransactionSpecification>
